Healthcare Provider Details

I. General information

NPI: 1801114129
Provider Name (Legal Business Name): INLAND CARDIOLOGY ASSOCIATES PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2010
Last Update Date: 05/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 W 7TH AVE SUITE 450
SPOKANE WA
99204-2332
US

IV. Provider business mailing address

122 W 7TH AVE SUITE 450
SPOKANE WA
99204-2332
US

V. Phone/Fax

Practice location:
  • Phone: 509-838-2960
  • Fax: 509-459-0424
Mailing address:
  • Phone: 509-838-2960
  • Fax: 509-459-0424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA6011816
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP30003426
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP30007150
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP30006427
License Number StateWA
# 5
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP30007497
License Number StateWA
# 6
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA10003131
License Number StateWA

VIII. Authorized Official

Name: LINDA A DURKIN
Title or Position: CREDENTIALLING MANAGER
Credential:
Phone: 208-664-4026